Neurodevelopmental follow-up of very preterm infants after proactive treatment at a gestational age of ≥23 weeks

Objective To determine the long-term neurodevelopmental outcome in extremely preterm infants after offering life support to all infants >= 23 weeks gestation ("pro-active management"). Study design With parental consent, all infants born at 23 to 25 completed weeks gestation were treated proactively. Surviving infants born from July 1996 to June 1999 were assessed for standardized cognitive and neurological outcomes at 5 years corrected age. Results 70 of 91 infants admitted to the neonatal intensive care unit survived until follow-up. 67 of die 70 surviving infants were examined at a median corrected age of 5.6 years; 12% had cerebral palsy and a Gross Motor Function Classification Scale score > 2; 4% were blind; 1% required a hearing aid; and 12% had a Kaufmann Assessment Battery for Children mental processing composite < 51, resulting in 18% sustaining a severe disability. 43% had normal results on a neurological examination, Gross Motor Function Classification Scale score = 0, mental processing composite > 85, and had neither severe visual nor hearing impairment. 57% qualified for regular schooling. Conclusion improved survival was not associated with an increased risk of severe disability when compared with results of earlier publications. These findings may result from proactive management and are important for counseling patients at risk of imminent extremely preterm delivery.